The changing role of beta-blocker therapy in patients with cirrhosis

Abstract

Cirrhosis is a leading cause of death in the United States and worldwide. Beta-blockers have been established in numerous studies as part of the cornerstone of the medical management of cirrhosis, particularly in the primary and secondary prevention of variceal hemorrhage. However, new evidence has cautioned the use of beta-blockers in patients with end-stage cirrhosis and refractory ascites. In this article, we review the beneficial effects of beta-blocker therapy, the potential harms of aggressive beta-blocker therapy, and provide suggestions regarding the appropriate use of this class of medications in patients with cirrhosis.

Non-Selective Beta-Blockers in Liver Cirrhosis: Friends or Foes? A Review of the Literature

“…Cirrhosis is becoming a leading cause of mortality and morbidity worldwide [1,2] , and since 1981, beta-blockers were found to be highly efficacious in both, primary and secondary prevention of variceal bleeding [3] . Non-selective beta-blockers (NSBB) became the cornerstone of the medical treatment of patients with cirrhosis [3] , and this was demonstrated in several solid studies.…”

“…Non-selective beta-blockers (NSBB) became the cornerstone of the medical treatment of patients with cirrhosis [3] , and this was demonstrated in several solid studies. However, recent evidence has questioned the use of beta-blockers in patients with end-stage liver disease and refractory ascites [3] .…”

“…option may be liver transplantation, and lately it is becoming a leading cause of mortality in the United States and worldwide [3] . The leading causes of cirrhosis comprise alcoholic liver disease, hepatitis C & B, and recently, non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatits (NASH) [3] .…”

“…The leading causes of cirrhosis comprise alcoholic liver disease, hepatitis C & B, and recently, non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatits (NASH) [3] . Cirrhosis is not only a cause of mortality but also a cause of morbidity and it may alter the lifestyle of the patients, especially when complications start to occur such as ascites, spontaneous bacterial peritonitis, variceal hemorrhage, hepatic encephalopathy, and cardiomyopathy, among others.…”

“…Non-selective beta-blockers (NSBB) became the cornerstone of the medical treatment of patients with cirrhosis [3] , and this was demonstrated in several solid studies. However, recent evidence has questioned the use of beta-blockers in patients with end-stage liver disease and refractory ascites [3] . In this article, we are going to review almost all the previous studies about beta-blocker therapy in patients with cirrhosis, and find out the beneficial effects of this therapy, its potential complications and harms, and try to provide suggestions regarding its appropriate use in this specific category of patients.…”